68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer

Klot, Christoph-Alexander Joachim von; Merseburger, Axel S.; Böker, Alena; Schmuck, Sebastian; Roß, Tobias L.; Bengel, Frank M.; Kuczyk, Markus A.; Henkenberens, Christoph; Christiansen, Hans; Wester, Hans‐Jürgen; Solaß, Wiebke; Lafos, Marcel; Derlin, Thorsten

doi:10.1007/s13139-017-0476-7

Cited by 52 publications

(41 citation statements)

References 35 publications

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“…Fendler et al (34) reported similar values of sensitivity and specificity for ECE and SVI detection. von Klot et al (35) reported a higher sensitivity of 90% and a similar specificity of 91% for the detection of ECE and similar values (75% and 100%) for the detection of SVI using 68 Ga PSMA-I&T PET/CT in a small cohort of 21 patients.…”

Section: Discussionmentioning

confidence: 74%

Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Muehlematter¹,

Burger²,

Becker³

et al. 2019

Radiology

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Background Recent studies have reported the additive value of combined gallium 68 (Ga)labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (hereafter called Ga-PSMA-11) PET/MRI for the detection and localization of primary prostate cancer compared with multiparametric MRI. Purpose To compare the diagnostic accuracy and interrater agreement of multiparametric MRI and Ga-PSMA-11 PET/MRI for the detection of extracapsular extension (ECE) and seminal vesicle infiltration (SVI) in patients with prostate cancer. Materials and Methods Retrospective analysis of 40 consecutive men who underwent multiparametric MRI and Ga-PSMA-11 PET/MRI within 6 months for suspected prostate cancer followed by radical prostatectomy between April 2016 and July 2018. Four readers blinded to clinical and histopathologic findings rated the probability of ECE and SVI at multiparametric MRI and PET/MRI by using a five-point Likert-type scale. The prostatectomy specimen served as the reference standard. Accuracy was assessed with a multireader multicase analysis and by calculating reader-average areas under the receiver operating characteristics curve (AUCs), sensitivity, and specificity for ordinal and dichotomized data in a region-specific and patient-specific approach. Interrater agreement was assessed with the Fleiss multirater. Results For multiparametric MRI versus PET/MRI in ECE detection, respectively, AUC, sensitivity, and specificity in the region-specific analysis were 0.67 and 0.75 (.07), 28% (21 of 76) and 47% (36 of 76) (.09), and 94% (529 of 564) and 90% (509 of 564) (.007). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.66 and 0.73 (.19), 46% (22 of 48) and 69% (33 of 48) (.04), and 75% (84 of 112) and 67% (75 of 112) (.19), respectively. For multiparametric MRI versus PET/MRI in SVI detection, respectively, AUC, sensitivity, and specificity of the region-specific analysis were 0.66 and 0.74 (.21), 35% (seven of 20) and 50% (10 of 20) (.25), and 98% (295 of 300) and 94% (282 of 300) (< .001). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.65 and 0.79 (.25), 35% (seven of 20) and 55% (11 of 20) (.20), and 98% (137 of 140) and 94% (131 of 140) (.07), respectively. Interrater reliability for multiparametric MRI versus PET/MRI did not differ for ECE (, 0.46 vs 0.40; = .24) and SVI (, 0.23 vs 0.33; = .39). Conclusion Our results suggest that gallium 68 (Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (Ga-PSMA-11) PET/MRI and multiparametric MRI perform similarly for local staging of prostate cancer in patients with intermediate-to-high-risk prostate cancer. The increased sensitivity of Ga-PSMA-11 PET/MRI for the detection of extracapsular disease comes at the cost of a slightly reduced specificity.

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Section: Discussionmentioning

confidence: 74%

Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Muehlematter¹,

Burger²,

Becker³

et al. 2019

Radiology

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“…Two additional articles were found upon additional screening of the reference lists. Finally, 12 studies including a total of 615 patients were included [26][27][28][29][30][31][32][33][34][35][36][37]. All 12 assessed SVI while 8 of them evaluated EPE.…”

Section: Literature Searchmentioning

confidence: 99%

“…All studies were of moderate to good quality, satisfying at 4 or more of the 7 domains in the QUADAS-2 tool except for one which only met 3 domains ( Figure 2). In the patient selection domain, 2 studies had unknown risk of bias as it was not clear whether the patient enrollment was consecutive or not [26,36]. One study had high concern for applicability as minority of the patients (2/50) had rising PSA after radiation treatment and these patients could not be separately analyzed from the other 48 with newly diagnosed prostate cancer [27].…”

Section: Quality Assessmentmentioning

confidence: 99%

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

Woo

Ghafoor

Becker

et al. 2020

Preprint

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Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).Methods: Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.Results: 12 studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95%CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95%CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95%CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95%CI 0.84-0.97] vs. 0.96 [95%CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, -0.234-0.908] between sensitivity and false-positive rate).Conclusion: PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI shows significantly greater sensitivity than PET/CT for assessing SVI.

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“…In the reference standard domain, all studies were at low risk of bias and concern for applicability. In the ow and timing domain, 6 studies had unknown risk of bias as the interval between PSMA-PET and prostatectomy was not provided [26,28,31,32,35,36].…”

Section: Quality Assessmentmentioning

confidence: 99%

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

Woo

Ghafoor

Becker

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).Methods: Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.Results: 12 studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95%CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95%CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95%CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95%CI 0.84-0.97] vs. 0.96 [95%CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, -0.234-0.908] between sensitivity and false-positive rate).Conclusion: PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.[S1] [S1]R1-1

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68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer

Abstract: Ga-PSMA I&T PET/CT prior to radical prostatectomy can contribute to presurgical local staging of prostate cancer. In this pilot study, Ga-PSMA I&T PET/CT showed promising results for prediction of lobe infiltration, ECE and SVI.

Cited by 52 publications

References 35 publications

Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

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68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer

Abstract: Ga-PSMA I&T PET/CT prior to radical prostatectomy can contribute to presurgical local staging of prostate cancer. In this pilot study, Ga-PSMA I&T PET/CT showed promising results for prediction of lobe infiltration, ECE and SVI.

Cited by 52 publications

References 35 publications

Diagnostic Accuracy of Multiparametric MRI versus 68Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Diagnostic Accuracy of Multiparametric MRI versus 68Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

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Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer

Diagnostic Accuracy of Multiparametric MRI versus ⁶⁸Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer